Nokea
The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for
- A. enalapril
- B. regular insulin
- C. levothyroxine
- D. dexamethasone
Correct Answer: D
Rationale: Thyroid storm requires blocking excess thyroid hormone effects. Dexamethasone reduces hormone release and inflammation. Enalapril is for hypertension, insulin for glucose, and levothyroxine worsens the condition.
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The nurse is educating a group of students on the effects of corticosteroids. It would be appropriate for the nurse to identify the following adverse effects associated with corticosteroids.
- A. Mood lability
- B. Immunosuppression
- C. Hypoglycemia
- D. Hyperkalemia
- E. Weight gain
Correct Answer: A, B, E
Rationale: Corticosteroids cause mood changes, suppress immunity, and promote weight gain via fluid retention and fat redistribution. They cause hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia.
The nurse cares for a 38-year-old female client recently diagnosed with Graves' disease. The client presents with a visibly enlarged thyroid gland, heat intolerance, excessive sweating, and unintentional weight loss. What additional signs or symptoms may be present in this client?
- A. Increased heart rate and palpitations
- B. Diarrhea and frequent bowel movements
- C. Tremors, particularly in the hands and fingers
- D. Eye changes such as exophthalmos
- E. Intolerance to cold temperatures
Correct Answer: A, B, C, D
Rationale: Graves' disease, a hyperthyroid condition, causes tachycardia, palpitations, diarrhea, tremors, and exophthalmos due to increased metabolism and autoimmunity. Cold intolerance is a hypothyroid symptom.
The nurse is interviewing a client taking prescribed methimazole for hyperthyroidism. Which assessment finding requires notification to the physician?
- A. body mass index (BMI) 23
- B. sore throat
- C. pulse (P) 84
- D. skin rash
Correct Answer: B
Rationale: Sore throat may indicate agranulocytosis, a rare but serious methimazole side effect, requiring immediate physician notification. BMI 23, pulse 84, and skin rash are less urgent unless severe.
The nurse preceptor observes a newly hired nurse care for a client with a myxedema coma. It would require follow up by the nurse preceptor if the newly hired nurse is observed
- A. applying a cooling blanket to the client.
- B. requesting a prescription for hydrocortisone.
- C. removing the water pitcher from the bedside.
- D. placing an oral endotracheal tube at the bedside for potential use.
Correct Answer: A
Rationale: Myxedema coma is a severe hypothyroid state with hypothermia. A cooling blanket worsens this; a warming blanket is needed. Hydrocortisone addresses adrenal insufficiency, removing water prevents dilutional hyponatremia, and an endotracheal tube is prudent for potential respiratory support.
The nurse is planning care for a client following bilateral adrenalectomy. The nurse should anticipate a prescription for which postoperative medication?
- A. Pantoprazole
- B. Propylthiouracil (PTU)
- C. Propranolol
- D. Hydrocortisone
Correct Answer: D
Rationale: Bilateral adrenalectomy removes adrenal glands, necessitating lifelong hydrocortisone replacement to provide glucocorticoids and prevent adrenal insufficiency. Pantoprazole, PTU, and propranolol are not indicated for this purpose.